POS0783 ASSOCIATION BETWEEN ENVIRONMENTAL FACTORS AND SALIVARY GLAND ULTRASOUND FINDINGS IN PATIENTS WITH SUSPECTED PRIMARY SJÖGREN SYNDROME
Authors: L. Barrio Nogal, M. Novella-Navarro, L. Sala-Icardo, A. Prada-Ojeda, C. Bohórquez, A. Pérez Gómez
Journal: Annals of the Rheumatic Diseases (2022)

Background The influence of environmental factors in primary Sjögren’s syndrome (pSS) and their relationship with serological, histological and ultrasound findings remains still poorly understood. A possible protective effect of female sex hormones and smoking has been related to a lower focal lymphocytic sialadenitis on the minor salivary gland biopsy (MSGB), but the relationship between histological findings and other chemical, toxic or dietary factors remains scarce or controversial, and even more so the relationship between these factors with salivary gland ultrasound (SGUS) findings, an emerging tool in the diagnostic and management of pSS. Objectives To analyze the relationship between sociodemographic, clinical and environmental factors with pathologic SGUS findings in patients with suspected pSS. Methods 72 patients with clinical and/or analytical suspicion of pSS were consecutively recruited. SGUS was performed: pathological (grade ≥2 according to Cornec et al system) vs non-pathological. Final diagnosis of pSS was made according to AECG, ACR/EULAR criteria and MSGB. Sociodemographic, clinical, analytical, activity indexes (ESSPRI and ESSDAI), environmental factors, toxic and dietary habits were collected. Chi-square and Fisher tests were used to compare qualitative variables and T-student and U-Mann Whitney tests, for quantitative variables (statistical significance p&lt;0.05). Defining pathologic vs non-pathologic US as the outcome variable, binomial logistic regression was performed for bivariate analysis, with calculation of Odds Ratio (OR) and 95% confidence interval (CI). Results 70.8% presented pathological SGUS, this percentage was significantly higher in patients with a definitive diagnosis of pSS (56.6% vs 26.6%; p=0.02). 97.2% were women with a mean age 57.3±11.8 years. Patients with pathological SGUS had in lower frequency a varied diet (64.2 vs 89.5; p=0.03), higher exposure to environmental toxics (71.1 vs 61.1; p=0.05), lower percentage of smokers (26.4 vs 52.6; p=0.03) and a lower mean age at menopause than patients with non-pathologic SGUS (47.3±3.9 vs 50.2±4.2; p=0.03). Significant differences were found in antiRo52 positivity and hypergammaglobulinemia. Bivariate analysis showed that menopause at younger age confers higher probability of presenting pathologic SGUS (OR=1.2 CI95% 1.02-1.41) and smoking was protective against pathologic SGUS (OR=0.32 CI95% 0.11-0.95). Hypergammaglobulinemia (OR=8.80 CI95% 2.27-34.02) and antiRo52 (OR=3.89 CI95% 1.14-13.20) imply an increased risk of pathological findings on SGUS. Conclusion Pathologic SGUS was more frequent in patients with definitive diagnosis of pSS, antiRo52 antibodies and hypergammaglobulinemia. Late menopause and smoking were protective factors against pathologic SGUS, and a tendency for a varied diet and absence of exposure to environmental chemicals. SGUS could be the initial diagnostic test in patients with suspected pSS and positive antiRo who have less exposure to estrogens, tobacco and mediterranean diet and greater exposure to chemicals. For this reason, SGUS could be useful in identifying modifiable environmental risk factors to decrease the incidence and severity of this disease, for which effective therapy is still lacking. References [1]Cornec D et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjögren’s syndrome: toward new diagnostic criteria? Arthritis Rheum. 2013 Jan;65(1):216-25 [2]Stone DU. Effect of Tobacco Smoking on The Clinical, Histopathological, and Serological Manifestations of Sjögren’s Syndrome. PLoS One. 2017 Feb6;12(2):e0170249. [3]Björk A. Environmental factors in the pathogenesis of primary Sjögren’s syndrome. J Intern Med. 2020 May;287(5):475-492. Disclosure of Interests None declared